Medicaid funding unfair to low income counties like St. Lawrence County

Wednesday, August 27, 2014 - 6:14 am

To the Editor:

New York counties are overburdened by state mandates, and the poorest counties get hit the hardest.

For example, New York is the only state in the entire nation that requires counties to pay a large share of Medicaid costs. Twenty-two states don’t require counties to pay any Medicaid costs at all. In 2011, New York counties paid a whopping 16% of Medicaid costs, according to the Citizen’s Budget Commission. This 16% is paid for by local property and sales taxes.

New Hampshire has the second highest county mandate, at 8%, or half that of New York. The next four highest states are Arizona at 4.9%, North Carolina at 4.7%, Iowa at 4.3%, and California at 2.5%. Most remaining states require counties to pay less than 1% of Medicaid costs.

The current government in Albany claims to have made great strides in Medicaid mandate relief for counties. But how much actual change has there been? In 2014, it is estimated that New York counties will pay about 15% of Medicaid costs. That’s not much lower than 16%, and it’s still far more than any other state in the country. That isn’t much “relief,” and no more “relief” is in sight.

This mandate is especially hard on lower income counties. The poorest counties in the state, which are also those with the most need for Medicaid, pay proportionately more for Medicaid than more affluent counties. In fact, St. Lawrence County pays the third highest Medicaid costs in the entire state when you compare county funded Medicaid costs to county incomes. By contrast, Albany County ranks 43rd, and affluent Westchester County ranks 55th.

The only fair way to distribute New York’s Medicaid cost is to pay for it at the state level. Albany politicians know this, and they have talked for decades about addressing the gross inequity. Unfortunately, all they have done is talked.